DNA image cytometric analysis of primary clear cell carcinoma of the liver

Eleven cases of clear cell hepatocellular carcinoma were evaluated for DNA ploidy by means of image analysis of Feulgen-stained tissue sections. The tumors displayed a trabecular or solid pattern and contained between 40% and 90% clear cells. Five tumors (45.4%) were diploid and six tumors (54.5%) were nondiploid (four aneuploid, one tetraploid, and one multiploid). The diploid tumors had no significant pleomorphism or mitotic activity, whereas the nondiploid tumors displayed a moderate to severe degree of pleomorphism and high mitotic rate. In addition, the nuclear area of the aneuploid tumor cells (55.3 microns2 +/- 5.4%, mean +/- SD) was significantly larger than that of the control hepatocytes (43.3 microns2 +/- 6.8%) (P = .01) and that of the diploid tumor cells (39.5 microns2 +/- 5.5%) (P = .001). We conclude that clear cell carcinoma of the liver comprises two groups: one with bland morphologic features and diploid DNA content and the other with aggressive morphologic features and aneuploid DNA content. We suggest that this finding may explain the discrepant literature reports regarding the prognosis of this tumor.